Investigating surgical recovery after head and neck reconstruction

[00:00:00] 主持人安珀·史密斯: 锡拉丘兹上州医科大学, 纽约邀请您成为“知情患者”，收听播客，介绍来自纽约中部唯一学术医疗中心的专家. 我是主持人，安柏·史密斯. 人们一直认为，如果接受头颈部重建手术的人在手术后的前五天内允许进食，那么他们更有可能出现并发症. An international team of researchers looked into that assumption, and we'll hear what they discovered from my guest, Dr. 哈尼族Aiash. 他是北州卫生专业学院负责跨专业研究的副院长, 他是这篇论文的资深作者. 欢迎回到“见多识广的病人”节目. Aiash.

[00:00:41] 哈尼族Aiash博士: 谢谢你，Amber.

[00:00:43] 主持人安珀·史密斯: 是否有很多外科医生认为患者在头颈部大范围手术后需要推迟几天进食?

[00:00:52] 哈尼族Aiash博士: 是的,琥珀. 在过去, 有一种观点认为，在手术后不久开始口服喂养或尽早拔掉喂食管, following significant head and neck reconstruction, 导致并发症增加. 近年来，专家们就头颈癌无组织瓣重建患者的围手术期护理达成了共识——正如(美国)增强恢复协会(术后)所概述的那样——2017年建议在手术后立即重新开始口服喂养. 然而, 因为传统, 在大多数情况下，使用游离皮瓣进行口腔重建手术的患者在NPO保留6至12天.

[00:01:46] 主持人安珀·史密斯: And NPO means nothing oral, nothing going through their mouth?

[00:01:50] 哈尼族Aiash博士: 是的.

[00:01:51] 主持人安珀·史密斯: 组织在暴露于食物和饮料之前需要时间来愈合的想法也是如此?

[00:01:59] 哈尼族Aiash博士: 他们是这样想的, 但我们的研究证明不是这样, 你可以利用早期喂养, 在这之后我们得到了很好的结果.

[00:02:10] 主持人安珀·史密斯: I want to hear more about those results, but let me make sure I understand. Now, the surgeries we're talking about mostly are done to remove cancers?

[00:02:18] 哈尼族Aiash博士: 是的. Free flap reconstruction is a surgical technique used in various medical specialties, primary and reconstructive surgery particularly, for areas with significant tissue loss or defects. Indication for free flap reconstruction include trauma, 切除肿瘤, 先天性缺陷, 不能正常愈合的慢性伤口, 或者整容重建, 举几个例子.

[00:02:46] 主持人安珀·史密斯: And the thinking or the fear of letting people eat soon after the surgery, 在这段时间里，病人是否可以通过其他方式接受营养而不是通过口腔?

[00:03:00] 哈尼族Aiash博士: 是的. In the old thinking they use parental or IV, or sometimes they use nasogastric tube. But to ensure that they receive adequate nutrition,在此期间, two main methods are commonly employed -- enteral feeding, 这种方法是通过鼻胃管将营养直接输送到胃肠道吗, 正如我告诉过你的, 或者一个鼻腔切口管，可以通过鼻子插入胃或小肠, 分别. 肠外营养. This involves delivering nutrients directly into the bloodstream by IV (intravenous) lines.

[00:03:39] 主持人安珀·史密斯: So if a patient needed any of those modes of nutrition, they would be in the hospital during that time, 正确的?

[00:03:47] 哈尼族Aiash博士: 是的.

[00:03:48] 主持人安珀·史密斯: 我看到. Now your study appears in the journal, Maxillofacial Plastic Reconstructive 手术. 是什么让你决定研究这个问题的?

[00:03:58] 哈尼族Aiash博士: 我们决定研究这个课题, as there is limited research about early feeding shortly after free flap surgery, 尤其是头颈癌之后. 我们的研究旨在收集早期开始口服喂养与术后并发症之间关系的证据, 样瘘管形成, 血清肿发展, 襟翼失效, 以及住院时间的长短，以建议在头颈癌患者自由皮瓣重建后实施早期口服喂养方案.

[00:04:36] 主持人安珀·史密斯: Now you used a few terms I wanted to ask you to define. 你说"瘘管"形成. 什么是瘘管?

[00:04:43] 哈尼族Aiash博士: 瘘管是一个意外的隧道，在你身体的两个部分之间形成，不应该连接. It can happen because of injury, infection, or other reasons.

皮瓣失效发生在手术皮瓣, 哪个是一张纸巾, moves from one area of the body to another area during surgery, partially or completely separates from its attachment site. 这可能是由于各种原因造成的，比如血液供应不足、感染、伤口紧张.

血肿是血液的集合, 大家都知道, 在颈部组织中积累, 而浆液的集合, 淡黄色清澈的液体, 在颈部组织中积累 is a seroma.

And one infection happens when harmful germs like bacteria, 进入伤口、结痂或手术切口.

[00:05:38] 主持人安珀·史密斯: You are listening to 推荐最近最火的赌博软件's "The Informed Patient" podcast. 我是主持人，安柏·史密斯. 我正在和医生谈话. 哈尼族Aiash, assistant dean for interprofessional research at 推荐最近最火的赌博软件's 卫生职业学院, and the lead author for the research paper we're discussing.

Now your team includes researchers from Saidi Arabia, 秘鲁, 埃及, 和查尔斯顿, 南卡罗来纳, 阅读, 宾西法尼亚, 纽约市. You looked back at paperwork for more than a thousand patients. 所有的病人都来自这些地区吗?

[00:06:10] 哈尼族Aiash博士: 我们的研究是荟萃分析. 荟萃分析是一种研究，它结合了来自特定主题的多个独立研究的数据，以提供更全面和统计上可靠的分析, 我们所说的增加力量.

We have found new studies about these topics from other countries, 比如我们的病人来自新西兰, UK, US, 和中国, 但我们是国际团队. We are working with many people to get these results, and not related to the sample size from these countries.

[00:06:48] 主持人安珀·史密斯: 为了让术语正确, early feeding means during the first five days after surgery, 晚喂食是5天或更晚?

[00:06:58] 哈尼族Aiash博士: 你说得对. We use the definition of early feeding using a cutoff point of five days, and as outlined in all the study included in our meta-analysis.

[00:07:09] 主持人安珀·史密斯: 好吧，让我们谈谈你的发现. 你是否发现在头颈部重建手术后五天内不让病人进食是合理的?

[00:07:18] 哈尼族Aiash博士: 我们有很多发现. We found there is no statistical difference between the complication, 在早期和晚期进食之间, 口腔喂食. 根据我们的结果, 我们的研究结果提示外科医生应考虑在头颈癌患者皮瓣重建后实施早期口服喂养方案.

Also we discovered that there is association between shorter hospital stay.

This can be due to several factors such as faster recovery, 口腔手术后不久进食有助于维持患者的营养状况和能量水平, 哪一种可以帮助身体愈合, 提高患者舒适度和满意度, 促进心理健康, 促进口腔组织愈合. In these cases they benefit from adequate nutrition to support healing and regeneration.

Proper nutrition can help, also, to reduce postoperative swelling and pain. 手术后的早期营养通常与并发症的风险降低有关.

[00:08:29] 主持人安珀·史密斯: 所以当我们谈到口服喂养时, after having a major surgery of the head and neck region, 是从液体开始的吗? 你是从软的食物开始的吗? I mean, there's got to be some guidelines, right?

[00:08:42] 哈尼族Aiash博士: 是的. 我们从液体开始. Then we begin gradually to give soft food, then hard food. 但通常我们从流质和软性食物开始.

[00:08:50] 主持人安珀·史密斯: So what would you like doctors and patients to take away from your study?

[00:08:55] 哈尼族Aiash博士: 病人, 我会告诉他们，做医学研究的主要原因是为了找到改善人们健康的新方法. 这项研究可以帮助医生和卫生保健专业人员为您提供最好的护理, 给病人, leading to the better outcome and quality of care for everyone. 然而, 在复杂的情况下，比如手术, 医生对病人特征的评估对于决定基于循证医学的最佳结果是至关重要的, 专门为你准备的.

所以病人听医生的话, especially when he applies evidence-based medicine, especially if we have research proof that early 口腔喂食 will help you.

对医生来说, I will tell them that to the best of our knowledge, 我们的研究是第一个针对早期口服喂养对各种术后并发症影响的荟萃分析, 以及头颈部自由皮瓣重建后的住院时间. And I believe it's excellent article to have a look at it, 特别是当我们证明早期和晚期口服喂养的并发症没有区别时——但我们也缩短了早期口服喂养的住院时间.

[00:10:20] 主持人安珀·史密斯: 听起来是基于你的研究, 把病人留在医院只是为了在手术后尽快喂饱他们并不是你需要这么做的原因. There may be other factors that the surgeons can concentrate on, but keeping them with adequate nutrition shouldn't be one of them.

[00:10:39] 哈尼族Aiash博士: 是的. 通常手术后是否留院取决于病人的恢复情况. As you know, we are doing personalized treatment. You cannot paint all the people with the same brush. 这就是我们所说的个性化医疗. 我们是不同的, 这就是为什么大多数患者在手术后通常会在医院呆10到14天. It really depends on each person's unique situation. Some studies have found that this time can be reduced to as little as six days.

[00:11:09] 主持人安珀·史密斯: 好吧,博士. Aiash, I really appreciate you making time to share your research with us.

[00:11:14] 哈尼族Aiash博士: Amber，非常感谢你邀请我. 谢谢你招待我.

[00:11:18] 主持人安珀·史密斯: 我的客人是博士. 哈尼族Aiash. 他是北州卫生专业学院负责跨专业研究的副院长. "The Informed Patient" is a podcast covering health, 科学与医学, brought to you by 锡拉丘兹上州医科大学, 纽约, 由吉姆·豪制作. Find our archive of previous episodes at gtlindia.net/informed. If you enjoyed this episode, please tell a friend to listen too. And you can rate and review "The Informed Patient" podcast on Spotify, 苹果播客, YouTube, 或者无论你收看什么节目. This is your host, Amber Smith, thanking you for listening.